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HEALTH  SCIENCES  STANDARD 


HX64080390 
RA807.N7  M56       A  health  census  of  C 


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A  Health  Census  of 
Chelsea  Neighborhood 

14th  to  42d  Streets 

5th  Avenue  to  the  Hudson  River 

Nev^  York  City 


Community  Sickness  Survey 

Conducted  by  the 

Metropolitan  Life  Insurance  Company 
and  the 

Chelsea  Neighborhood  Association 


Metropolitan  Life  Insurance  Compaq' 

New  York 

1917 


CHELSEA  HEALTH  CENSUS^ 


Fifth  Community  Sickness  Survey 


Health  conditions  have  been  for  several  years  the  subject 
of  serious  consideration  in  the  Chelsea  neighborhood,  14th  to 
42d  Streets,  5th  Avenue  to  the  Hudson  River,  New  York  City. 
Various  public  and  philanthropic  agencies  in  the  district  have 
approached  the  problem  from  numerous  angles.  The  Chelsea 
Neighborhood  Association  through  its  health  committee,  has 
devoted  considerable  time  and  energy  to  constructive  and 
preventive  health  measures.  This  committee  of  the  Neighbor- 
hood Association,  Dr.  B.  H.  Lewinski-Corwin,  Chairman,  in 
the  early  part  of  April,  1917,  approached  the  Metropolitan  Life 
Insurance  Company  with  the  suggestion  that  the  Company, 
through  its  agents  in  Chelsea,  make  a  health  census  of  the 
neighborhood,  similar  to  those  previously  conducted  in  Roches- 
ter, Boston  and  in  other  places,  so  as  to  establish  the  basis  for 
a  constructive  health  programme  in  the  future.  The  Company 
agreed  to  undertake  the  work  with  the  cooperation  of  the 
Neighborhood  Association,  the  census  to  be  taken  during  the 
two  weeks  following  April  23d. 

lyOCAi,  Conditions. 

Before  entering  into  the  details  of  the  census  and  its  findings, 
it  may  be  well  briefly  to  touch  upon  general  conditions  in  the 
Chelsea  neighborhood  as  related  to  public  health. 

Chelsea  contains  about  180,000  residents.  The  district 
presents  all  the  problems  of  a  good-sized  city.  It  contains 
some  desirable  residential  areas,  separated  from  a  considerably 
larger  number  of  congested  poorer  sections;  its  thoroughfares 
are  devoted  to  ofl5.ces,  small  shops  and  to  some  of  the  largest 
manufacturing  plants  in  the  country.     Many  of  the  residents 

*The  census  was  made  under  the  direction  of  Dr.  Lee  K.  Frankel,  Third  Vice-President 
of  the  Metropolitan  Life  Insurance  Company,  Dr.  Louis  I.  Dublin,  Statistician  of  that 
Company,  and  Dr.  E.  H.  Lewinski-Corwin,  Chairman  of  the  Health  Committee  of  the 
Chelsea  Neighborhood  Association.  Mr.  Edward  H.  Pfeiffer,  Secretary  of  the  Neighbor- 
hood Association,  assisted  in  planning  the  census  and  in  preparing  the  report. 

1 


are  native-born  Americans,  who  have  lived  in  Chelsea  for 
several  generations,  and  hark  back  to  Irish,  English  or  Ger- 
man stock.  A  large  number  of  Itahans,  Greeks,  French, 
Spaniards  and  Poles  are  also  to  be  found  in  the  district. 

Chelsea  contains  some  125  civic  and  social  agencies — " 
churches,  hospitals,  day  ntuseries,  schools,  milk  stations, 
settlements,  hbraries,  public  baths,  playgrounds,  social  clubs 
and  the  like — and  a  Neighborhood  Association  with  over  five 
hundred  members,  representing  the  broader  mutual  interests 
of  residents,  business  men  and  property  owners.  It  is  one 
of  the  oldest  sections  of  the  city,  rich  in  historic  memories  and 
fine  houses  of  a  former  period.  It  has  the  finest  docks  in  the 
city,  the  Pennsylvania  Railroad  Terminal,  Chelsea  Park  and 
several  smaller  recreation  spaces,  and  the  well-known  London 
Terrace  and  Chelsea  Cottages. 

Yet  with  all  these  facilities  the  district  has  its  serious 
problems.  It  had  a  death  rate*  in  1915  of  19.28  per  1,000,  and 
an  infant  mortality  rate  of  121.4  per  1,000  births.  The  atten- 
tion of  philanthropic  agencies  has  been  for  many  years  chiefly 
riveted  upon  the  East  Side,  and  it  is  therefore  not  to  be  wondered 
at  that  conditions  among  the  West  Side  poor  are  often  most 
deplorable.  As  will  be  pointed  out  later,  the  section  needs 
better  and  more  modem  pubHc  school  buildings,  added  recrea- 
tional facilities  for  young  and  old  and,  more  especially,  improved 
housing  for  many  of  its  people. 

Chelsea  Neighborhood  Association. 

In  1913  a  small  group  of  Chelsea  people  formed  the  Chelsea 
Neighborhood  Association  "to  make  Chelsea  a  better  place 
to  live  and  work  in."  From  modest  beginnings  the  Association 
has  grown  to  a  membership  of  over  five  hundred,  and  the 
breadth  of  its  scope  is  indicated  by  the  fact  that  the  Association 
has  standing  committees  on  health,  housing,  schools,  recreation, 
employment,  policing  and  immigration.  The  Association  is  a 
neighborhood  clearing  house  for  Chelsea's  agencies  and  has 
during  the  past  four  years  interested  itself  in  nearly  every 
type  of  problem  known  to  social  or  civic  workers. 

*On  the  basis  of  a  population  of  about  140,000  people  in  the  New  York  City  Health 
Department  sanitary  areas  whoUy  included  in  Chelsea  neighborhood. 


The  Neighborhood  Association's  request  to  the  MetropoHtan 
Life  Insurance  Company  for  a  Chelsea  health  census  met  with 
a  hearty  response  from  the  Company.  Its  Third  Vice-President, 
Dr.  Ivce  K.  Frankel,  and  Statistician,  Dr.  Louis  I.  DubUn, 
immediately  conferred  with  the  Neighborhood  Association  to 
plan  the  survey.  Mr.  T.  W.  Ridgway,  Superintendent  of  the 
Company's  Chelsea  district,  with  his  forty  agents,  on  April  23d 
began  taking  Chelsea's  health  census,  after  the  Association  had 
paved  the  way  by  a  thorough  pubUcity  campaign. 

PuBuciTY  Campaign. 

During  the  week  preceding  the  healtlj  census  the  Neighbor- 
hood Association  distributed  throughout  Chelsea  10,000  4-page 
folders;  "Chelsea's  Chance."  The  folder  emphasized  the  fact 
that  the  census  aimed  to  multiply  the  advantages  of  living  in 
the  neighborhood.  This  was  foimd  to  be  a  tactful  and  effective 
method  of  neighborhood  advertising.  These  folders  were  left 
directly  with  families  or  distributed  through  churches,  hbraries, 
schools,  milk  stations,  clinics  and  other  agencies.  The  folder 
briefly  urged  the  neighbors  to  cooperate  by  answering  aU 
questions  to  the  best  of  their  abihty,  requested  neighbors  to 
report  to  the  Association  at  any  time  any  health  menaces 
and  gave  a  list  of  all  health  agencies  in  the  district,  which  might 
be  kept  for  handy  reference. 

In  addition,  fifteen  Chelsea  motion  picture  theatres  ran 
shdes  annoimcing  the  census  to  their  audiences,  the  slides 
being  accompanied  by  an  original  cartoon  drawn  by  the  weU- 
known  artist,   Hy.  Mayer. 

A  vigorous  publicity  campaign  through  the  English  and 
foreign  language  press  was  also  made,  and  articles  appeared  in 
numerous  leading  magazines  and  other  publications. 

Dr.  Hermann  M.  Biggs,  New  York  State  Commissioner  of 
Health,  issued  a  statement  saying,  "I  think  this  admirable 
plan  should  be  of  great  value  not  only  to  Chelsea,  but  also  to 
other  portions  of  the  city,  where  Chelsea's  example  ought  to  be 
followed,"  and  Health  Commissioner  Dr.  Haven  Emerson  of 
New  York  City,  declared  that,  "The  Department  of  Health 
welcomes  cooperation  of  this  sort.  Only  by  first  ascertaining 
what  are  the  health  conditions  in  a  community  can  we 
undertake  effective  corrective  measures." 


Clergymen  announced  the  plan  for  the  census  to  their 
Chelsea  congregations,  and  Chelsea  business  concerns  told  their 
employees  of  the  undertaking. 

Principai,  Findings  of  the  Census. 

The  same  general  methods  of  inquiry  were  pursued  in 
taking  the  Chelsea  health  census  as  were  followed  by  the 
Metropolitan  Life  Insurance  Company  in  its  health  enumera- 
tions of  other  representative  communities  in  the  United  States. 
The  inquiry  form  contained  the  usual  items  to  which  was 
added  a  special  housing  query  to  ascertain  the  number  of 
persons  per  room. 

The  completed  schedules  were  sent  to  the  Home  OflBce  for 
the  preparation  of  the  necessary  statistical  tables  and  these 
are  offered  in  the  following  discussion. 

In  all,  5,983  families  were  reached  by  the  agents,  and  in 
these  families  the  health  status  of  24,043  persons  was  ascer- 
tained. There  were  356  sick  persons  enmnerated,  or  at  a  rate 
of  14.8  per  1,000  registered. 

Among  21,700  white  persons,  318  were  fotmd  to  be  sick  or 
at  a  rate  of  14.7  per  1,000.  Colored  persons  were  enumerated 
in  2,343  instances,  among  whom  there  were  38  sick  persons, 
or  at  a  rate  of  16.2  per  1,000.  Sickness  involving  disability 
for  work  was  discovered  in  331  cases,  or  at  a  rate  of  13.8  per 
1,000;  among  the  group  of  white  persons,  295  cases  involving 
disabihty  for  work  were  discovered,  and  among  colored  persons 
36  cases  These  correspond  to  rates  of  13.6  and  15.4  per 
1,000  respectively. 

Extent  of  Disability, 

The  number  of  cases  of  sickness  showing  physical  disability 
for  work  constituted  93.0%  of  the  total  registered.  Persons 
bed-fast  at  home  were  counted  in  73  cases,  or  20.5%  of  the 
total.  Persons  sick  in  hospital  were  found  in  56  cases,  or  15.7% 
of  the  total  cases  of  sickness.  Ambulant  cases  imable  to  work 
were  discovered  in  202  cases,  or  56.7%  of  the  total  illnesses 
registered.  Of  the  latter,  32  were  recei\dng  dispensary  treat- 
ment; this  constituted  9.0%  of  the  total  cases  of  sickness. 
The  sicknesses  involving  no  disability  to  work  amotmted  to 
only  25  in  the  entire  sur\-ey,  or  7.0%  of  the  total  sickness 
registered.      It  must  be  remembered  that  the  agents  were 

4 


instructed  not  to  register  trivial  diseases  and  injuries,  but  only- 
such  as  involved  physical  disability  for  work  or  which  were 
serious  enough  to  be  of  economic  significance. 

Sickness  by  Sex  and  by  Age  Period. 

The  sickness  statistics  of  this  Chelsea  health  census  were 
classified  also  according  to  sex  and  by  age  periods.  Among 
11,373  males  at  all  ages,  169  cases  of  sickness  involving  disa- 
bility for  work  were  discovered.  This  constituted  a  rate  of  14.9 
per  1,000  registered.  The  sickness  rate  for  males  was  least 
in  the  ages  under  15  years,  8.3  per  1,000,  and  highest  in  the  age 
period  55  and  over,  61.1  per  1,000. 

Among  12,670  females  there  were  162  cases  of  sickness 
discovered  where  the  patient  was  disabled  for  work.  This  is 
equivalent  to  a  rate  of  12.8  per  1,000  registered.  The  sickness 
rate  was  again  least  for  those  under  15  years  of  age  and  greatest 
for  the  age  period  55  years  and  over.  These  figures  however 
when  arranged  according  to  sex  and  by  age  period  for  each 
sex  are  based  upon  too  few  cases  to  warrant  any  final  con- 
clusions on  the  sickness  rate  according  to  these  categories  in 
Chelsea  neighborhood.  Yet  there  is  close  enough  correspond- 
ence between  the  statistical  results,  when  thus  arranged,  and 
the  material  previously  developed  by  the  Metropolitan  Life 
Insurance  Company's  other  sickness  surveys,  to  justify  the 
conclusion  that  the  sickness  statistics  of  this  survey  are  based 
upon  trustworthy  original  data. 

Diseases  and  Conditions  Discovered  in  the  Survey. 

The  cases  of  communicable  disease,  for  instance,  were 
tabulated  in  detail,  showing  the  name,  address,  sex  and  age 
of  patient  and  disease,  and  this  information  was  given  to  the 
New  York  City  Department  of  Health  as  an  auxiliary  check 
upon  the  reporting  of  conununicable  disease  in  Chelsea.  The 
Health  Department  informed  the  Association  that  most  of  the 
cases  of  contagious  diseases  thus  reported  were  known  to  the 
Health  Department  and  that  the  diagnoses  given  by  the 
fa^^iHes  to  the  visiting  agents  were  correct.         ^ 

By  far  the  greatest  number  of  cases  for  any  particular 
disease  or  condition  were  reported  for  rheumatism,  of  which 
there  were  recorded  51  cases.  "Rheumatism"  is  very  fre- 
quently a  diagnosis  of  obscure,  conditions,  simulating  rheiunatic 

5 


disease,  on  the  part  of  the  laity  as  well  as  of  physicians.  By 
this  term  is  covered  a  multitude  of  ailments. 

Accidents  and  injuries  were  next  in  importance  with  39 
cases,  of  which  16  were  specified  as  fractures,  4  as  injuries  due 
to  falling,  and  19  as  unspecified  accidents  and  injuries.  Pneu- 
monia was  registered  in  16  cases,  diseases  of  the  stomach  in 
13  cases,  diseases  of  the  kidneys  in  11  cases,  and  paralysis 
(imspecified  cause),  likewise,  in  11  cases.  The  sequelae  of 
infantile  paralysis  were  recorded  in  2  instances. 

There  were  only  12  cases  of  pulmonary  tuberculosis  recorded, 
and  4  cases  of  other  types  of  tuberculosis,  but  there  were  4  cases 
of  "limg  trouble"  of  which  2  were  of  over  a  year's  duration, 
6  cases  of  bronchitis  of  which  2  were  over  two  year's  duration, 
3  cases  of  pleurisy  of  which  1  was  of  a  year's  standing,  a  case 
of  "run  down,"  and  some  other  similar  designations  of  con- 
ditions which  led  one  to  suspect  that  they  were  probably 
pulmonary  tuberculosis.  Should  allowance  be  made  for  these 
suspicious  cases,  and  even  if  they  were  entered  as  tuberculosis, 
the  total  amount  of  the  disease  discovered  in  the  survey  was 
comparatively  very  small.  This  was  probably  due  to  the  fact 
that  many  cases  of  the  first  and  second  stages  were  either 
unrecognized  or  if  known  to  the  family  were  not  given  to  the 
agents.  According  to  the  records  of  the  Health  Department 
there  were  285  new  cases  of  tuberculosis  reported  in  Chelsea 
for  the  first  quarter  of  1917.  This  gives  a  gauge  of  the  preva- 
lence of  this  disease  in  Chelsea.  The  health  survey  agents 
presumably  reached  only  those  cases  of  tuberculosis  which  were 
in  the  last  stage  of  the  disease  and  were  totally  unable  to  work 
or  to  conceal  their  malady. 

The  principal  facts  of  these  aspects  of  the  health  census 
are  shown  in  the  table  on  opposite  page. 

Character  of  Medical  Service. 

Out  of  the  total  cases  of  sickness  registered,  255,  or  71.6%, 
had  medical  attendance  of  one  kind  or  another.  In  166  cases,  or 
65.1%  of  the  total  ha^dng  any  kind  of  medical  service,  a  private 
physician  was  employed;  hospitals  were  caring  for  56  cases, 
or  22.0%  of  the  total  showing  medical  service.  Thirty- three 
cases  out  of  the  total  showing  attendance  of  a  physician  were 
being  treated  at  dispensaries.  This  latter  number  constituted 
12.9%  of  the  total  with  any  kind  of  medical  attendance  specified. 

6 


Tabls  1. 

Number  of  Cases  of  Specified  Diseases  and  Conditions.    Total 

Sick  Persons,    Chelsea  Neighborhood  Census,  New 

York  City.     Classified  by  Age  Period. 


DISEASE  OH  CONDITION 

All  diseases  and  conditions 

Malaria 

Measles 

Scarlet  fever 

Diphtheria  and  croup 

Influenza 

Dysentery 

Mumps 

Septicemia 

Tuberculosis  of  the  lungs 

Tuberctdosis  other  than  pulmonary  type . 

Cancer — all  forms 

Tumor 

Rheumatism 

Diabetes 

Anemia 

Locomotor  ataxia 

"Spinal  trouble" 

Sequelae  of  "infantile  paralysis" 

Apoplexy 

Paralysis — unspecified 

Insanity 

Epilepsy 

Neuritis 

"Rundown" 

"Nervousness" 

Feebleminded 

Blind . 

Other  diseases  of  the  eyes 

Diseases  of  the  ears 

Heart  diseases 

Arterio-sclerosis 

Varicose  ulcers 

Disease  of  lymphatic  system 

Hemorrhage 

"Colds" 

"  Nose  trouble  " 

Bronchitis 

Pneumonia 

Pletuisy 

Asthma 

"Lung  trouble " 

Tonsillitis 

Tonsillar  abscess 

Diseases  of  stomach 

Herniae 

Gall  stones 

Diseases  of  liver 

Diseases  of  kidneys 

"Miscarriage" 

Maternity  cases 

Diseases  of  the  skin 

Traumatism  by  fall 

Fractures — cause  unspecified 

Other  and  unspecified  accidents  and  injuries  . 

Dropsy 

Crippled,  lame 

"Sore  leg" 

"  Operation  " 

Other  and  unspecified  diseases 


All  Ages 


356 


2 
1 

3 
4 
7 
1 
1 
5 

12 
4 
2 
1 

51 
3 
2 
1 
4 
2 
3 

11 
4 
1 
3 
1 
6 
4 
7 
3 
2 
9 
3 
3 
2 
2 
4 
2 
6 

16 
3 
7 
4 
8 
1 

13 
3 
3 
5 

11 
1 
3 
5 
4 

16 

19 
3 
8 
3 
3 

35 


Under 
15 


61 


15  to  34 


83 


1 
11 


35  to  54 

l23 


1 
3 
6 

1 

i 

20 

1 

i 
1 

i 

6 

1 


1 

2 

10 

9 

2 

2 

i 

7 


*Probably  sequel  of  "infantile  paralysis." 


Hospital  Care  of  Sickness  est  Chelsea. 

As  Chelsea  has  only  two  general  hospitals  within  its  bounda- 
ries, a  goodly  number  of  cases  made  use  of  these  two  institutions. 
Nineteen  went  to  the  New  York  Hospital  and  4  to  the  French 
Hospital.  The  remainder  went  to  the  hospitals  outside  of  the 
district.  Bellevue  Hospital  accommodated  21  and  presumably 
these  were  surgical  cases  and  people  acutely  ill.  Two  chronic 
cases  went  to  the  hospital  on  Blackwell's  Island.  It  is  rather 
surprising  that  the  hospitals  in  the  near  vicinity  of  Chelsea, 
such  as  the  Polydinic  and  St.  Vincent's,  received  no  more  than 
2  cases  each,  while  2  cases  went  to  the  ICnickerbocker  Hospital 
on  135th  Street,  1  to  Mount  Sinai,  1  to  Hudson  Street  Hospital 
and  1  to  the  Post-Graduate  Hospital.  Two  cases  of  insanity 
were  taken  to  the  Manhattan  State  Hospital  and  1  to  Central 
Islip.  St.  Mary's  Hospital  for  Children  was  availed  of  in  only 
one  instance.  Two  cases  of  tuberculosis  went  to  Sea  View 
Hospital,  1  to  Seton  Hospital  and  1  to  an  unspecified  sana- 
torium. Two  cases  went  to  Willard  Parker  Hospital  for  the 
treatment  of  contagious  diseases. 

The  scattering  of  patients  among  the  hospitals  is  probably 
a  normal  distribution  of  cases  among  institutions  in  a  city 
like  New  York,  where,  with  the  stupendous  hospital  problem 
to  be  dealt  with,  there  is  no  regulative  machinery  of  any  kind 
in  existence. 

The  surprisingly  small  number  of  dispensary  cases,  namely, 
33  in  all  out  of  a  total  of  255  seeking  medical  advice,  is  probably 
due  to  the  nature  of  the  survey  which  emphasized  only  cases  of 
serious  iUness. 

Duration  of  Cases  of  Sickness. 

The  agents  who  enumerated  the  sicknesses  in  this  health 
census  inquired  also  for  the  duration  of  sickness  up  to  the  date 
of  enumeration.  The  356  cases  were  distributed  according 
to  the  duration  of  the  sickness  up  to  the  date  of  the  inquiry 
and  the  tabulated  facts  are  shown  in  the  table  on  opposite  page. 

Out  of  the  total  number  of  cases  with  duration  of  sickness 
.specified,  30,  or  9.0%  were  sick  less  than  one  week.  Only 
16.5%  were  sick  for  less  than  two  weeks,  and  42.0%  for  less 
than  two  months.  The  duration  of  illness  of  the  majority  of 
the  cases  discovered  (54.9%)  was  over  three  months.  There  are 
evidently  many  chronic  types  of  illness,  particularly  among 
the  males,  for  while  41.6%  of  women  were  ill  for  a  period  longer 

8 


Table  2. 

Duration  of  Sickness — Chelsea  Health  Census  Cases — Total  Sick 

Persons. 


DURATION  OF  SICKNESS 


TOTAL 


Number   PerCent? 


Maues 


Number    Per  Cent 


Femaus 


Number    Per  Cent 


All  durations. 


356 


100.0 


186 


100.0 


170 


100.0 


1  day 

Over  1  day,  under  1  week . 

1  week,  under  2  weeks .... 
2Veeks,  under  3  weeks.  .  . 
S^weeks,  under  1  month .  . 
l^month,  under  2  months . 

2  months,  under  3  months . 
S^months,  under  6  months , 
6  months,  under  1  year . . . 
1  year,  imder  3  years 

3  years  and  over 

Unspecified 


2 
28 
25 
23 
30 
32 
10 
37 
33 
48 
65 
23 


.6 

8.4 

7.5 

6.9 

9.0 

9.6 

3.0 

11.1 

9.9 

14.4 

19.5 


2 

12 
11 

8 
16 
17 

5 
22 
18 
25 
36 
14 


1.2 

7.0 

6.4 

4.7 

9.3 

9.9 

2.9 

12.8 

10.5 

14.5 

20.9 


16 
14 
15 
14 
15 

5 

IS 
15 
23 
29 

9 


9. 

8. 
9 
8. 
9 
3, 
9 
9 
14 


9 

7 
3 
7 
3 
1 
3 
3 
3 
18.0 


♦Duration  of  sickness  specified. 

than  six  months,  45.9%  of  men  suffered  from  protracted  mala- 
dies. Sixty-five  cases,  or  19.5%  of  the  total  with  duration 
of  illness  specified  were  sick  three  years  or  more. 

PRE"VTeNTION  OF  ChRONIC   DISABLING  SiCKNESS. 

Through  the  census  7  cases  of  blindness  and  9  cases  of 
heart  disease  were  foimd.  The  Neighborhood  Association  had 
special  visits  made  upon  aU  these  persons  and  each  set  of  con- 
ditions was  carefully  investigated.  Among  the  7  cases  of 
blindness,  5  were  found  to  be  already  in  touch  with  the  New 
York  Association  for  the  Blind,  one  case  was  in  need  of  aid 
and  one  case  had  evidently  moved  without  lea\'ing  the  new 
address  and  so  could  not  be  relocated.  Of  the  9  cardiac  cases, 
2  were  under  hospital  care,  6  were  in  jthe  care  of  private 
physicians  and  1  had  moved  out  of  the  city  since  the  taking 
of  the  census.  It  is  doubtful  whether  the  51  cases  of 
"rheumatism"  have  ever  received  any  instruction  in  personal 
hygiene  or  in  dietetics.  No  data  are  at  hand  as  to  whether 
those  discovered  sick  had  made  any  provision  for  meeting 
the  economic  contingencies  arising  from  sickness. 

Housing. 
In  the  health  survey  was  included  an  item  as  to  the  ntunber 
of  rooms  occupied  by  the  families  visited,  with  a  view  to 
discovering  if  there  was  any  correlation  between  housing  and 

9 


health.  At  the  outset  it  was  considered  doubtful  whether 
this  inquiry  would  bear  fruitful  results,  and  the  investigation 
entirely  sustained  these  doubts.  It  was  not  possible  to  establish 
any  correlation  between  sickness  and  housing.  Much  interesting 
information,  however,  as  to  the  housing  conditions  in  the 
district  was  obtained.  It  was  found  that  25.0%  of  the  families 
li\'ed  in  three-room  apartments,  38.6%  in  four-room  apart- 
ments and  14.7%  in  five-room  apartments.  In  other  words, 
close  to  80%  of  the  families  lived  in  apartments  ha\'ing  from 
3  to  5  rooms.  In  examining  the  table,  one  may  be  surprised 
to  see  that  there  are  such  a  large  number  of  single  persons 
li\-ing  in  apartments,  consisting  of  3,  4  and  5  rooms,  but 
these  are  probably  persons  who  were  boarding  with  famihes 
occupj'ing  as'  many  rooms.  It  is  also  possible  that  those 
classified  in  the  first  line  of  the  table  were  in  some  cases  the 
ordinary'  life  insurance  policN^-holders  of  the  Company,  and 
these  were  of  higher  economic  status. 

The  table  shows  that  there  is  an  appreciable  amount  of 
over-crowding  in  the  district.  For  instance,  there  were  242 
families  with  4  persons  each  li\"ing  in  3  rooms,  118  famihes  of 
5  li\-ing  in  3  rooms,  60  families  of  6  li\"ing  in  3  rooms,  33  families 
of  7  living  in  3  rooms  and  9  cases  of  families  of  8  li\dng  in^3 
rooms.  Similarly,  there  were  194  famihes  of  6  li\'ing  in  4  rooms, 
90  famihes  of  7  li\4ng  in  4  rooms,  48  of  8  li\TJig  in  4  rooms, 
34  of  9  living  in  4  rooms,  and  11  of  more  than  10  living  in  4 
rooms. 

The  Tenement  House  Department  also  has  suppHed  the 
Association  with  some  interesting  data  relative  to  housing 
conditions  in  Chelsea.  The  neighborhood  contains  3,210 
tenements,  3,167  of  which  are  "old  law"  houses.  Of  these, 
273  are  rear  tenemrtits,  built  behind  houses  fronting  on  the 
street.  The  Department  reports  that  63  tenements  contain 
462  dark  rooms  against  which  orders  are  pending.  Yard 
toilets  in  the  rear  of  tenements  are  found  in  599  houses,  the 
total  number  of  fixtures  being  1,920. 

Chelsea  Sewer  System. 

Since  local  health  conditions  are  often  seriously  affected 

by  sewer  facihties,    the  Association   has  inquired   into   that 

subject,  and  the  Bureau  of  Sewers  of  the  Citv^  has  supphed  the 

facts  relative  to  Chelsea's  system.     Since  sewerage  is  a  matter 

10 


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11 


which  lies  \nth  the  local  improvement  boards  and  steps  for 
better  facilities  cannot  be  initiated  by  the  City,  this  is  almost 
entirely  a  neighborhood  problem. 

The  Bureau  of  Sewers  reports  that  the  greater  part  of  the 
original  sewer  system  was  built  from  1840  to  1860,  although 
many  minor  branches  were  built  subsequently.  Many  of 
these  older  sewers  are  in  very  poor  condition,  due  both  to  their 
age  and  to  inferior  materials  in  use  at  the  time  they  were  built. 
When  the  sewage  reaches  the  waterfront  it  is  carried  in 
wooden  barrels  out  to  the  end  of  a  pier  where  it  is  discharged 
into  the  river  without  treatment  of  any  kind.  This  practice  has 
caused  the  accumulation  of  banks  of  sewage  sludge  along  the 
waterfront  and  results  in  unsightly  and  perhaps  unhealthful  con- 
ditions at  the  sewer  outlet.  In  certain  locations  the  odors  from 
this  acciunulation  had  been  such  as  to  cause  serious  complaints. 

Days  Lost  by  Wage-Earners  Because  of  Sickness. 

As  in  the  other  sickness  siu^eys  conducted  by  the  Metro- 
pohtan  Life  Insurance  Company  among  the  wage-earning 
part  of  the  population  in  representative  American  commimities, 
approximately  1.5%  of  the  population  enumerated  was  found 
to  be  seriously  sick.  For  the  group  of  males  aged  15  years  or 
more  the  sickness  rate  invoMng  disabilit}^  for  work  was  17.6 
per  1,000  registered.  This  leads  to  the  conclusion  for  Chelsea 
neighborhood  that  between  5  and  6  da3"s  are  lost  each  year  by 
adult  wage-earners  on  account  of  serious  sickness.  The  period 
in  pre\'ious  sur\^eys  was  somewhat  longer. 

Results. 

Important  results  of  the  census  cannot  be  expected  within  so 
short  a  time,  yet  a  number  of  interesting  developments  growing 
out  of  the  health  survey  are  worth}-  of  mention  here. 

The  agents  of  the  Metropolitan  Life  Insurance  Company 
did  much  useful  work  in  the  survey,  noting  cases  of  extreme 
poverty,  unemployment  and  need  of  fresh  air  relief  as  well  as 
of  sickness.  WTien  the  census  was  completed,  all  such  cases 
were  referred  to  the  Chelsea  Neighborhood  Association,  which 
in  cooperation  with  other  Chelsea  agencies  tried  to  solve  each 
family's  distressing  problems. 

Cases  of  poverty  were  handled  through  the  Charity  Organiza- 
tion Societ}',  Chelsea  and  Lowell  branches;  the  Association  for 
Improving  the  Condition  of  the  Poor;  the  St.  Vincent  de  Paul 

12 


Society  and  neighborhood  churches.  Unemployment  cases 
were  handled  through  the  Neighborhood  Association's  own 
employment  bureau  and  fresh-air  reUef  cases  through  the 
Association's  special  fresh-air  committee.  Some  of  the  children 
found  iU  and  in  need  of  special  summer  attention  were  referred 
to  the  Hudson  Guild,  a  Chelsea  neighborhood  settlement,  for 
intensive  treatment  during  the  hot  months  along  the  lines  of 
noiuishment,  recreation  and  physical  training. 

Requests  were  received  during  the  census,  from  organiza- 
tions devoted  to  work  vnth  the  blind,  crippled  and  deaf,  for  any 
information  relative  to  their  field  which  the  census  may  have 
brought  to  hght,  and  similar  data  was  sought  by  agencies 
interested  in  housing  conditions.  The  Neighborhood  Asso- 
ciation in  all  cases  made  available  to  the  several  organizations 
the  desired  information.  It  is  certain  that  as  a  result  of  this 
cooperative  work  Chelsea  will  reap  many  benefits. 

Cases  of  sickness  were  referred  to  the  Cit\"  Health  Depart- 
ment's several  bureaus  and  wherever  further  attention  was 
needed  proper  steps  were  taken. 

The  census  revealed  the  need  and  special  value  of  a  neigh- 
borhood association  as  a  center  for  a  district's  social  and  ci\-ic 
activities,  especially  along  health  lines.  The  practical  results 
already  achieved  by  the  Neighborhood  Association  in  Chelsea 
clearly  indicate  that  other  conmiunities  throughout  the  country 
may  materially  profit  by  organizing  neighborhood  associations 
and  thus  enable  their  citizens  to  participate  in  local  move- 
ments for  health  and  civic  betterment. 

Since  the  Neighborhood  Association  is  more  than  likely  to 
follow  out  in  great  measiure  the  programme  outlined  below, 
the  Chelsea  neighborhood  may  be  stne  to  gain  much  lasting 
and  constructive  good  from  its  health  census.  Furthermore, 
it  is  confidently  hoped  that  other  municipahties  will  see  the 
advantages  of  neighborhood  association  work  in  a  programme 
of  civic  betterment. 

CONCl,USIONS   AND    PlANS. 

The  health  survey  has  afforded  an  approximate  indication 
of  the  prevalence  of  illness  in  Chelsea.  The  census  showed 
almost  15  cases  of  serious  illness  per  1,000  people,  and  on  the 
assmnption  that  this  rate  appHes  throughout  the  year,  there 
are  estimated  to  be  over  2,700  cases  of  serious  sickness  in 
Chelsea  district  all  the  time.     A  minor  part  of  the  illness  is 

13 


due  to  the  acute  contagious  diseases,  such  as  measles,  scarlet 
fever  and  diphtheria.  Much  of  it  is  due  to  degenerative 
diseases  of  the  heart,  blood  vessels  and  kidneys,  while  some 
is  due  to  tuberculosis  and  t}T5hoid  fever. 

A  great  deal  of  sickness  is  unavoidable,  but  a  good  proportion 
can  be  prevented  either  directly  by  the  exercise  of  proper  care 
by  individuals  or  indirectly  by  closer  observance  of  definite 
rules  of  public  hygiene.  Efiicient  public  health  administration 
on  the  part  of  the  City  authorities  is,  of  course,  an  indispensable 
community  measure.. 

Through  its  Health  Department  the  City  is  spending  over 
J3,000,000  annually  to  protect  the  health  of  its  citizens  and 
is  accomplishing  appreciable  results.  It  is,  however,  handi- 
capped in  reaching  a  still  higher  degree  of  efficiency  by  the 
lack  of  cooperation  on  the  part  of  the  average  man  and  woman, 
who  are  careless  in  their  habits  of  life  and  behavior  toward 
others.  Promiscuous  spitting  in  street  cars  and  unprotected 
sneezing  and  coughing  are  responsible  for  many  cases  of  tuber- 
culosis, pneumonia  and  other  diseases  of  like  nature,  which 
are  spread  from  man  to  man. 

The  neighborhood  is  the  first  link  in  general  community 
action  for  better  health.  Among  neighbors,  health  matters 
can  and  are  being  discussed  more  freely  and  intimately  than 
among  any  other  large  group  of  people.  The  findings  in  the 
Chelsea  health  survey  lead  to  the  conclusion  that  an  educational 
campaign  should  be  begim  among  the  neighbors  to  promote 
a  better  knowledge  of  health  rules  and  to  inculcate  the  principles 
of  wholesome  community  living. 

The  Association  proposes  to  enlarge  its  health  committee 
so  that  it  will  include  representatives  from  every  important 
social  agency  in  the  district,  from  every  hospital,  dispensary 
and  nursing  organization  working  within  the  neighborhood 
boundaries.  Through  such  an  enlarged  and  representative 
committee  it  would  seem  possible  to  keep  in  touch  with  the 
existing  agencies  doing  health  work  in  the  district  and  to  give 
advice  to  neighbors  on  various  matters  of  personal  and  collective 
interest.  The  Association  will  probably  endeavor  to  raise 
funds  to  enable  it  to  employ  a  qualified  nurse  who  would  be 
in  constant  touch  with  all  the  agencies  of  the  district,  who  will 
act  as  the  executive  officer  of  the  health  committee  and  who 
will  advise  at  all  times  with  neighbors  desiring  mstruction  and 
guidance. 

14 


Thanks  to  the  health  census,  the  Association  now  possesses 
information  about  the  district,  which  can  be  enlarged  gradually, 
so  that  in  time  it  will  have  a  considerable  grasp  upon  the  living 
and  working  conditions  of  the  people  in  Chelsea.  The  Associa- 
tion's members  aim  to  be  in  direct  neighborly  relations  with  all 
whom  they  know  personally.  The  Association  will  also  en- 
deavor to  keep  in  constant  touch  with  the  Health  Department 
by  assisting  medical  inspectors,  nurses  and  other  agents  of  the 
Department  in  their  numerous  activities  and  by  keeping  thenl 
informed  of  local  health  conditions.  Infractions  of  the  sani- 
tary code,  which  the  neighbors  may  report  to  the  Association, 
and  which  the  Association  may  be  unable  to  rectify  itself 
promptly  by  neighborly  persuasion,  will  be  reported  to  the 
Department  of  Health. 

The  Association  will  keep  in  touch  with  the  Street  Cleaning 
Department  to  see  that  its  work  is  done  thoroughly  and  ex- 
peditiously and  will  help  that  Department  as  well  as  the 
neighborhood  by  calling  the  attention  of  the  neighbors  to  the 
value  of  a  clean  neighborhood,  free  from  Htter,  rubbish,  dirt 
and  garbage,  in  which  flies  and  disease  germs  thrive  abundantly. 
Similarly,  the  Association  plans  to  cooperate  with  the  Tenement 
House  Department,  and  to  report  to  the  Commissioner  all 
cases  of  neglect  by  inspectors  and  will  also  keep  that  Depart- 
ment informed  of  menaces  to  life  and  health  which  come  to 
its  attention.  In  this  connection  it  will  be  well  to  remind  the 
neighbors  constantly  that  dark  rooms,  overcrowding  and 
stagnant  air  are  powerful  aUies  of  tuberculosis  and  other 
diseases.  The  Association  will  endeavor  to  work  with  the 
Police  Department  in  curbing  immorality  and  crime  in  the 
district,  and  will  continually  impress  upon  Chelsea's  people 
the  dire  individual  and  social  effects  of  venereal  diseases, 
alcohol,  and  habit-forming  drugs,  such  as  morphine,  cocain 
and  heroin.  The  Association  will  take  steps  to  improve  the 
neighborhood's  sewerage  system. 

Working  with  the  various  public  health,  civit  and  philan- 
thropic agencies  of  the  district,  as  well  as  with  those  of  the 
city,  the  Association  hopes  to  be  able  to  advise  the  neighbors 
Authoritatively  and  accurately  as  to  where  to  secure  the  best 
advice  whenever  they  or  their  families  develop  sickness  or 
meet  with  any  difficulties.  Many  neighbors,  who  were  reached 
through  the  health  census,  require  hospital  or  convalescent 
care.     They  are  being  put  in  touch  with  the  proper  agencies. 

15 


Many  Chelsea  children  need  attention  to  assure  proper  nourish- 
ment and  some  the  opportunity  to  spend  the  simimer  in  the 
open  air  outside  the  city.  The  Neighborhood  Association  is 
addressing  itself  to  these  needs. 

Some  children  of  the  district  are  feeble-minded  and  should 
not  be  allowed  to  be  misused  by  other  children  and  by  incon- 
siderate adults.  They  should  be  placed  in  institutions  estab- 
lished by  the  City  or  State  for  this  purpose. 

Many  of  the  sick,  who  were  visited  in  the  district,  could 
derive  more  benefit  from  instruction  as  to  diet  and  the  rudiments 
of  health  than  from  medication.  The  Association  will  endeavor 
to  persuade  the  dispensaries  in  the  neighborhood  to  print 
circulars  of  instruction  and  to  distribute  them  to  sick  neighbors 
who  apply  for  medical  advice,  the  circulars  to  deal  with  proper 
dietetics  for  the  sick  as  well  as  for  the  well.  Steps  will  also  be 
taken  to  disseminate  information  as  to  the  value  of  various 
foods  and  as  to  the  economics  of  food  consumption,  a  matter 
of  primary  importance  in  the  present  national  crisis. 

Mothers  of  sick  babies,  who  cannot  afford  the  services  of 
private  physicians,  will  be  urged  to  bring  their  children  to  the 
baby  welfare  stations  maintained  by  the  Department  of  Health. 
Measures  wall  be  provided  to  help  the  blind,  the  deaf  and  the 
crippled  of  the  neighborhood  to  obtain  vocational  education 
and  secure  adequate  employment. 

The  health  census  revealed  many  conditions  calHng  for 
rehef.  By  a  programme  such  as  above  outlined,  the  Associa- 
tion hopes  to  improve  conditions  considerably. 

It  is  hoped  that  the  findings  of  this  survey  and  the  remedial 
measures  proposed  by  the  Chelsea  Neighborhood  Association 
will  serve  as  an  indication  to  other  communities  throughout 
the  country  of  what  can  be  accomplished  through  neighborly 
interest  and  activity.  The  Metropolitan  Life  Insurance 
Company  has  cooperated  in  this  work  and  has  made  the  results 
available  with  this  end  in  view.  The  experiment  can  be  re- 
peated generally  and  profitably  by  other  cities  and  by  wards 
within  the  cities.  An  increase  in  our  intensive  knowledge  of 
local  health  and  social  conditions  will  result,  and  higher 
commimity  health  standards  will  inevitably  follow  such  a 
programme. 


16 


COLUMBIA   UNIVERSITY 

1  his   Ix.ok   is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

O 

■^HTji'    -.--"i 

,  rf'^ 

^ 

v^ 

w 

C28(e3B)M80 

iU807.J\77 
Metro 


M56 


^     ^°''^^  life  ir^s 

f  health  ..-.  •   "°-^>.y. 


census.  _ 


